THEODORE SCOTT DERSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139601

License Status

NOT RENEWED

Business

Title

First Name

THEODORE

Middle

SCOTT

Last Name

DERSE

Business Name

THEODORE SCOTT DERSE MD

Original Issue Date

01/13/2016

Effective Date

05/04/2017

Expiration Date

09/30/2020

City

KENOSHA

State

Zip

53144

County

WISCONSIN

Ever Disciplined

LastModifiedDate

01/14/2021